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Technology stocks have largely been in favor since the COVID-19 pandemic began, but re-openings in the U.S. and elsewhere as vaccines take hold have pushed investors toward value stocks, which are geared more toward the economy. But lately, stronger growth expectations are also sparking worries of higher inflation, and a potential tapping of the brakes by central banks.
Therefore, an important concept for physicians and all investors to understand is the Current Rate of Return (CCR).
So, What Exactly is CRR?
According to this principle, the current rate of a taxable return must be evaluated in reference to a similar non-taxable rate of return. This allows you to focus on your portfolio’s real (after-tax return), rather than its’ nominal, or stated return. Since most medical professionals own a combination of both vehicles, it is important to calculate the average rate of return (ARR), as demonstrated in the following matrix. Usually, this will result in the assumption of more risk, for the possibility of great return.
To compare after tax yields, with taxable yields, use the following formulas:
Tax equivalent yield = yield / (1 – MTB), while taxable yield X (1-tax rate) = tax exempt yield.
Example: if the yield on a tax exempt municipal bond was 6%, and you are in a 28% tax bracket; the equivalent taxable yield (ETY), is 8.3%, calculated in the following manner: 06 / 1.00 – .28 =.083, or, 8.3% ETY.
This means that you would need a taxable instrument paying almost 9 % to equal the 6 percent tax exempt bond.
President Biden plans to end both the public health and national emergencies originally declared to address the Covid pandemic in 2020 (and extended several times since) on May 11th 2023.
The White House just disclosed the plan while opposing efforts by Republican lawmakers to end the emergency declarations immediately with a bill called the Pandemic Is Over Act. The end of the emergencies will mean that many Americans will have to start paying for COVID tests, treatments, and vaccines.
It also signals a shift in how serious the government considers the pandemic to be. But, is this wise?
You’ve got a sense of your ideal retirement age. And you’ve probably made certain plans based on that timeline. But what if you’re forced to retire sooner than you expect? Aging baby-boomers, corporate medicine, the medical practice great resignation and/or the pandemic, etc?
Early retirement is nothing new, but it’s clear how much the COVID-19 pandemic has affected an aging workforce. Whether due to downsizing, objections to vaccine mandates, concerns about exposure risks, other health issues, or the desire for more leisure time, the retired general population grew by 3.5 million over the past two years—compared to an annual average of 1 million between 2008 and 2019—according to the Pew Research Center.1 At the same time, a survey conducted by the National Institute on Retirement Security revealed that more than half of Americans are concerned that the COVID-19 pandemic has impacted their ability to achieve a secure retirement.2
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There’s no need to panic, but those numbers make one thing clear, says Rob Williams, managing director of financial planning, retirement income, and wealth management for the Schwab Center for Financial Research. Flexible and personalized financial planning that addresses how you’d cope if you had to retire early can help you make the best use of all your resources.
So – Here are six steps to follow. We’ll use as an example a person who’s seeing if they could retire five years early, but the steps remain the same regardless of your individual time frame.
Step 1: Think strategically about pension and Social Security benefits
For most retirees, Social Security and (to a lesser degree) pensions are the two primary sources of regular income in retirement. You usually can collect these payments early—at age 62 for Social Security and sometimes as early as age 55 with a pension. However, taking benefits early will mean that you get smaller monthly benefits for the rest of your life. That can matter to your bottom line, even if you expect Social Security to be merely the icing on your retirement cake.
On the Social Security website, you can find a projection of what your benefits would be if you were pushed to claim them several years early. But if you’re part of a two-income couple, you may want to make an appointment at a Social Security office or with a financial professional to weigh the potential options.
For example, when you die, your spouse is eligible to receive your monthly benefit if it’s higher than his or her own. But if you claim your benefits early, thus receiving a reduced amount, you’re likewise limiting your spouse’s potential survivor benefit.
If you have a pension, your employer’s pension administrator can help estimate your monthly pension payments at various ages. Once you have these estimates, you’ll have a good idea of how much monthly income you can count on at any given point in time.
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Step 2: Pressure-test your 401(k)
In addition to weighing different strategies to maximize your Social Security and/or pension, evaluate how much income you could potentially derive from your personal retirement savings—and there’s a silver lining here if you’re forced to retire early.
Rule of 55
Let’s say you leave your job at any time during or after the calendar year you turn 55 (or age 50 if you’re a public safety employee with a government defined-benefit plan). Under a little-known separation-of-service provision, often referred to as the “rule of 55,” you may be able take distributions (though some plans may allow only one lump-sum withdrawal) from your 401(k), 403(b), or other qualified retirement plan free of the usual 10% early-withdrawal penalties. However, be aware that you’ll still owe ordinary income taxes on the amount distributed.
This exception applies only to the plan (including any consolidated accounts) that you were contributing to when you separated from service. It does not extend to IRAs.
4% rule
There’s also a simple rule of thumb suggesting that if you spend 4% or less of your savings in your first year of retirement and then adjust for inflation each year following, your savings are likely to last for at least 30 years—given that you make no other changes to your withdrawals, such as a lump sum withdrawal for a one-time expense or a slight reduction in withdrawals during a down market.
To see how much monthly income you could count on if you retired as expected in five years, multiply your current savings by 4% and divide by 12. For example, $1 million x .04 = $40,000. Divide that by 12 to get $3,333 per month in year one of retirement. (Again, you could increase that amount with inflation each year thereafter.) Then do the same calculation based on your current savings to see how much you’d have to live on if you retired today. Keep in mind that your money will have to last five years longer in this instance.
Knowing the monthly amount your current savings can generate will give you a clearer sense of whether you’ll have a shortfall—and how large or small it might be. Use our retirement savings calculator to test different saving amounts and time frames.
Step 3: Don’t forget about health insurance, doctor!
Nobody wants to spend down a big chunk of their retirement savings on unanticipated healthcare costs in the years between early retirement and Medicare eligibility at age 65. If you lose your employer-sponsored health insurance, you’ll want to find some coverage until you can apply for Medicare.
Your options may include continuing employer-sponsored coverage through COBRA, insurance enrollment through the Health Insurance Marketplace at HealthCare.gov, or joining your spouse’s health insurance plan. You may also find discounted coverage through organizations you belong to—for example, the AARP.
Step 4: Create a post-retirement budget
To make sure your retirement savings will cover your expenses, add up the monthly income you could get from pensions, Social Security, and your savings. Then, compare the total to your anticipated monthly expenses (including income taxes) if you were to retire five years early and are eligible, and choose to file, for Social Security and pension benefits earlier.
Take into account various life events and expenditures you may encounter. You may not pay off your mortgage by the date you’d planned. Your spouse might still be working (which can add income but also prolong certain expenses). Or your children might not be out of college yet.
You’re probably fine if you anticipate that your monthly expenses will be lower than your income. But if you think your expenses would be higher than your early-retirement income, some suggest that you take one or more of these measures:
Retire later; practice longer.
Save more now to fill some of the potential gap.
Trim your budget so there’s less of a gap down the road.
Consider options for medical consulting or part-time work—and begin to explore some of those opportunities now.
To the last point, finding a physician job later in life can be challenging, but certain employment agencies specialize in this area. If you can find work you like that covers a portion of your expenses, you’ll have the option of delaying Social Security and your company pension to get higher payments later—and you can avoid dipping into your retirement savings prematurely.
When you retire early, you have to walk a fine line with your portfolio’s asset allocation—investing aggressively enough that your money has the potential to grow over a long retirement, but also conservatively enough to minimize the chance of big losses, particularly at the outset.
“Risk management is especially important during the first few years of retirement or if you retire early,” Rob notes, because it can be difficult to bounce back from a loss when you’re drawing down income from your portfolio and reducing the overall number of shares you own.
To strike a balance between growth and security, start by making sure you have enough money stashed in relatively liquid, relatively stable investments—such as money market accounts, CDs, or high-quality short-term bonds—to cover at least a year or two of living expenses. Divide the rest of your portfolio among stocks, bonds, and other fixed-income investments. And don’t hesitate to seek professional help to arrive at the right mix.
Many people are unaccustomed to thinking about their expenses because they simply spend what they make when working, Rob says. But one of the most valuable decisions you can make about your life in retirement is to reevaluate where your money is going now.
This serves two aims. First, it’s a reality check on the spending plan you’ve envisioned for retirement, which may be idealized (e.g., “I’ll do all the home maintenance and repairs!”). Second, it enables you to adjust your spending habits ahead of schedule—whichever schedule you end up following. This gives you more control and potentially more income.
Step 6: Reevaluate your current spending
For example, if you’re not averse to downsizing, moving to a less expensive home could reduce your monthly mortgage, property tax, and insurance payments while freeing up equity that could also be invested to provide additional monthly income.
“When you are saving for retirement, time is on your side”. You lose that advantage when you’re forced to retire early, but having a backup plan that anticipates the possibility of an early retirement can make the unknowns you face a lot less daunting.
After last week’s sharp decline, the S&P is down 5.7% so far in April and is on track for its worst monthly drop since March 2020, when the spreading COVID-19 pandemic blasted stocks.
And, battered U.S. stocks are facing a potentially painful stretch in the weeks ahead as hawkish Federal Reserve policy, rising bond yields, geopolitical uncertainty and the corporate earnings season fuel investor unease. For example:
REPORTINGCOMPANIES:
Monday: Germany business climate; Earnings from PepsiCo and Whirlpool
Tuesday: US consumer confidence; Earnings from 3M, General Electric, JetBlue, UPS, Warner Bros. Discovery, Alphabet, General Motors, Mondelez, Microsoft and Visa
Wednesday: Earnings from Boeing, Harley-Davidson, Kraft Heinz, Spotify, Ford Motor, Mattel, Meta and PayPal
Thursday: Bank of Japan policy decision; US first quarter GDP; Earnings from Caterpillar, Altria, Domino’s Pizza, Mastercard, Twitter, Amazon, Apple, Intel, Roku and Robinhood
Friday: Europe first quarter GDP and inflation data; US personal income and spending data; PCE Price Index; Earnings from ExxonMobil and Chevron
One measure of investor anxiety, the CBOE Volatility Index, known as Wall Street’s fear gauge, on Friday notched its largest one-day gain in about five months to close at a five-week high of 28.21.
Q: What is the plan for a future with COVID? A: A new 136-page report written by dozens of experts provides a comprehensive roadmap to the next normal both to address the pandemic and protect against future biosecurity threats. The group identified 12 key areas of focus, including long COVID, equity, and vaccines. The report also addressed concerns about how the end of the pandemic will disrupt the U.S. health care system when policies introduced during the public health emergency come to an end.
Last week was a bit rudderless with anecdotal stories in the stock market — like Elon Musk buying a big chunk of Twitter (TWTR) — pushing and pulling market sentiment.
But, as with the heart of any earnings season, the big banks will be among the first to put up Q1 numbers. According to Zacks Director of Research Sheraz Mian in his latest Earnings Trends piece this week, all the big banks, including JPMorgan Chase (JPM), Bank of America (BAC), Citigroup (C) and Wells Fargo (WFC), have seen lower revisions ahead of the reports. This is especially true with Citi, which has higher exposure to Russia.
And, global venture funding dropped 19% from Q4 2021 to the first quarter of this year—the steepest drop in at least four years, according to CB Insights. The number of companies that nabbed “unicorn” status (a valuation of at least $1 billion) fell to a five-quarter low.
Finally, the average number of US COVID-19 cases has hit its highest level in a month, but due to the draw-down in testing centers and the uptick of at-home tests, experts assume that many cases are going unreported. Dr. Fauci opined that we must assess our own risk levels, which reflects the US’ shift in strategy to treat Covid like an endemic disease.
In case you missed it: If you or a loved one are 50 or older, or are moderately or severely immunocompromised, you can get an additional Pfizer or Moderna COVID-19 booster shot at no cost to you.
The CDC recommends an additional booster shot for certain individuals to increase protection from severe disease from COVID-19. People over the age of 50, or who are moderately or severely immunocompromised, can get an additional booster of Pfizer or Moderna 4 months after their last dose.
This is especially important for those 65 and older who are at higher risk from severe disease and most likely to benefit from getting an additional booster.
Learn More: Remember: Medicare covers the COVID-19 vaccine, including booster shots, at no cost to you. Find a COVID-19 vaccine location near you.
Our broken healthcare supply chain – what can be done
By Dr. Marion Mass MD
Dr. Marion Mass graduated from Medical School at Duke University. She completed internship and residency at Northwestern University’s Robert Lurie Children’s Hospital in Chicago. Dr. Mass has worked in the Philadelphia area as a pediatrician for 21 years.
Markets: Wednesday’s surge was brief as stocks sank yet again following failed peace talks between Russian and Ukrainian officials. RIVIAN investors lost about $117 billion in market capitalization in the last four months due to concerns around its production capabilities.
Government: The Senate approved a $1.5 trillion spending bill that will fund the government for the current fiscal year and provide $13.6 billion in aid for Ukraine.
WHO: In the US…March 25th, the day Hawaii—the only remaining state with an indoor mask mandate—lifts its mask requirements and April 18th, when the CDC’s loosened guidance for mask mandates on public transportation is expected to take effect. These moves would mean virtually all Covid restrictions would be lifted, marking the unofficial end of the pandemic in the states. Globally…the WHO has been meeting every three months to decide whether or not to continue calling Covid a “pandemic.” The group is expected to keep the label through April—and most likely June as well—and with it, a number of programs that directly help low-income countries. But if the WHO removes the label, then projects like Covax to help vaccinate low-income nations and pledges from drug companies to leave patents off Covid drugs could disappear. And, Harvard epidemiologist Caroline Buckee told Science that the ultimate decision to end the pandemic would come down to “an opinion-based consensus” from within the the WHO.
MARKETS: The S&P 500 fell into a correction for the first time in two years, joining the NASDAQ Composite, as Russia sent troops into pro-Russian regions in Ukraine. The S&P 500 index ended down 1% at 4,304.76, below the correction level at 4,316.91, which would represent a 10% drop from its January 3rd record close. A correction is commonly defined by market technicians as a fall of at least 10% (but not greater than 20%) from a recent peak. The last time the S&P 500 entered a correction was February 27th 2020, when the market was being whipsawed by fears about the outbreak of the COVID pandemic.
And, this bearish market isn’t sparing 2021 winners like Home Depot, which fell the most in nearly two years after supply-chain bottlenecks squeezed its margins. HD was the Dow’s biggest gainer last year.
IRS: According to a news release issued by the IRS, taxpayers now have the option to verify their identities during live, virtual interviews with agents. The agency stresses that no bio-metric data will be required for those interviews.
However, taxpayers once again have the option to verify their identity using ID.me’s facial recognition services. Addressing privacy concerns, the IRS says new requirements are in place to ensure that images provided will be deleted upon verification. That would apply to any new IRS accounts created and those where selfies have already been collected.
Endemic: A constant presence and/or usual prevalence of a disease or infection, such as the Corona virus, within a geographic area. (Hyperendemic is a situation in which there are persistent high levels of disease occurrence.)
StocksMarkets: The stock indexes surged higher—and the Dow [DJIA] had its best day of 2022. Just how volatile was the market this week? The S&P swung at least 2.25% every single day…and ended up on Friday afternoon around where it will start today Monday morning.
Economy: New data showed that overall compensation climbed 4% annually last quarter, the biggest jump in two decades. That’s still not enough to keep up with inflation, which is climbing at its fastest pace since 1983.
PANDEMIC: Americans are not OK during the pandemic. According to the General Social Survey, the share of people who said they were “very happy” plunged from 31% in 2018 to 19% in 2021, while the share of people who were “not too happy” surged from 13% to 24%. Over the past few decades, the very happy people had outnumbered the not-too-happies by about three to-one.
Stock Markets: US stocks staged a big afternoon comeback for the second day in a row … but still not big enough to close in the green. American Express was the top performer in both the S&P and the Dow after the company reported its highest billings volume ever in Q4. And, enthusiasm over meme stocks more broadly appears to be dwindling along with cryptos. And, while NASDAQ took a hit, Microsoft reported quarterly sales of more than $50 billion for the first time ever.
Economy: The weight of the financial world is on Jerome Powell’s shoulders today. The Federal Reserve chair will provide an update on the central bank’s views on sky-high inflation and its plan for interest rate hikes this year (though none are expected until March).
Pandemic: Pfizer and BioNTech started clinical trials for an Omicron-specific vaccine yesterday. The results will help the pharma partners decide whether to replace their current jab formula with one that targets the most dominant Covid variant. The new vaccine is being tested both as a three-shot series for un-vaccinated participants and as a booster for the already vaccinated.
Stock Markets: The S&P is off to its worst start to a year since 2016. The NASDAQ is in a correction. And the week ahead features a busy earnings slate and a Federal Reserve meeting.
CovisPandemic: Tony Dr. Fauci said he is “confident as you can be” that the Omicron wave in the US will peak by mid-February. In a growing number of states, that peak has already come and gone and cases are plunging in states like New York and Florida. Other states, such as Oklahoma, Idaho, and Wyoming, are still reporting an uptick in new Covid cases.
Crypto-Currency: Crypto investors, meanwhile, wish they got the weekend off like stock traders, because bitcoin, ethereum, and other digital tokens continued to sink.
Federal Reserve: Federal Reserve officials will get together on Tuesday and Wednesday against the backdrop of quaking markets. Investors will want to hear an update on Chair Jerome Powell’s views on inflation. This Fed meeting will likely be the last before an anticipated interest rate hike in March. And, a blizzard of companies will report including nearly half of the Dow’s 30 giants (American Express, 3M, IBM, and more) and tech heavyweights such as Apple, Microsoft, and Tesla.
Tax Season: The income tax filing season opens today and government officials warn it could be bumpy due to a depleted IRS. The Treasury says to file early, file online, and request your refund via direct deposit to avoid the severe headaches.
Stock Markets: The S&P and NASDAQ suffered their worst week since the pandemic began, tumbling 5.7% and 7.55%, respectively. But Peloton bounced back after Thursday’s wipe-out when CEO John Foley assured employees that execs “feel good about right-sizing our production.”
Covid Pandemic: A third dose of either Moderna or Pfizer-BioNTech’s Covid vaccine provided significant protection against severe disease in the US, according to three real-world reports that dropped yesterday. One analysis showed that the boosters were 90% effective at preventing hospitalization.
The majority of COVID-19 patients being treated in hospitals are unvaccinated or have not received a booster dose of the vaccine. These hospitalizations show how vaccines work and highlight the importance of continued vaccination efforts. President Biden has emphasized that vaccines, boosters, and therapeutic drugs have lessened the danger of COVID-19 for vaccinated people.
Vaccine Recommendations: A new recommendation from the CDC says that people who were initially immunized with the Pfizer vaccine should now receive their booster dose after five months, down from six. Some people with weakened immune systems will soon be eligible for a fourth dose of the COVID-19 vaccine and an Omicron specific vaccine could be ready by March.
Vaccine Mandates:The Supreme Court is weighing the Biden administration’s requirement that workers get vaccinated or be tested regularly for COVID-19. Many states and cities have created their own vaccine rules and employers are left confused about what to do next during the legal battles and the current rise in cases.
At-Home Testing Shortage: There is a shortage of COVID-19 at-home test kits and kit prices are rising as are reports of price gouging. The White House announced a policy to make at-home tests freely available to Americans. Learn more about at-home tests and their accuracy here.
Antiviral Pills:Doctors express concern that the limited supply of antiviral drugs is unlikely to ameliorate the strain hospitals are experiencing. The U.S. doubled its order for Pfizer’s COVID pill so there’s enough for 20 million people.
Stock Markets: An inflation report couldn’t stop stocks from pushing higher yesterday, likely because it wasn’t worse than expected. Biogen shares tumbled after Medicare said it would limit coverage of its controversial $28,000 Alzheimer’s drug, Aduhelm; as the ME-P has noted.
Covid Pandemic: The current Omicron wave is projected to peak by January 19th in the US, according to an influential model from the University of Washington. Then, cases are expected to plummet “simply because everybody who could be infected will be infected,” Washington professor Ali Mokdad told the AP. Cases appear to have already peaked in Britain.
Stock Markets: Down more than 2% with its back against the wall, the NASDAQ staged a huge comeback yesterday afternoon to close in the green and snap a 4-day losing streak.
Pandemic: Moderna was the S&P 500’s top performer after its CEO said that a booster shot targeting Omicron would soon enter clinical trials. Pfizer also said its Omicron booster would be ready by March.
Economy: A growing number of finance experts are taking the over when it comes to the number of interest rate hikes this year. Goldman Sachs now predicts the Fed will raise rates four times in 2022 (more than previously forecast) and JPMorgan CEO Jamie Dimon said he’d be surprised if it were only four hikes.
IRS: Even though tax filing season is just around the corner (opening January 24th with an April 18th deadline), the typically joyful and charismatic IRS has a case of the blues. On Monday, the Treasury Department warned that the agency has had a rough year and taxpayers should expect delays as returns are processed. According to Treasury officials, budget cuts and pandemic-related staffing shortages have created a towering backlog at the agency, and a “frustrating season” is on the horizon. While the IRS typically enters filing season with about 1 million unaddressed returns, the number stood at around 8.6 million in mid-Nov. 2021.
The Omicron variant spreads more easily than the original virus that causes COVID-19. Here are 3 things you can do to help protect yourself and others:
Get the COVID-19 vaccine, if you haven’t already. Vaccines are the best tool to protect us from COVID-19. They slow the transmission of the virus, and provide strong protection against severe illness and hospitalization.
Get the booster when you’re fully eligible. Everyone 18 years and older should get a booster shot 2 months after their Johnson & Johnson vaccine, or 5 months after completing their primary COVID-19 vaccination series of Pfizer-BioNTech or Moderna. Adolescents and teens ages 12 to 17 should also get a booster of Pfizer-BioNTech 5 months after their primary series.
Entering the Last Chapter of Covid, From Omicron and Beyond – With Dr. James R. Baker, Jr., M.D.
Richard Helppie welcomes back University of Michigan Professor Emeritus of Internal Medicine, and Virologist, Dr. James R. Baker, Jr., M.D., who brings words of both encouragement and warning as the world comes to what he feels is the beginning of the final throws of the Covid-19 pandemic.
Dr. Baker has been a valued guest on the Common Bridge since the beginnings of the coronavirus over a year ago, and brings thoughtful, scientific, data-driven analysis to the most significant health issue of our lifetime.
66% of Nurses Expressed Consideration to Leave The Profession
A survey of 570 nurses between May and June 2021 found:
• 66% of nurses expressed some level of consideration to leave the profession. • 97% of polled participants agree, that increases to pay rates and other incentives would attract and retain nurses. • 58% agree that tele-health should be a cornerstone of care delivery. • 85% believe that we must improve cross training to adapt to crisis events. • 85% strongly believe national licensure would have greatly benefited the country during the pandemic.
Markets: Stocks dropped sharply in the post-Thanksgiving trading session on Friday due to concerns over the new Covid variant, Omicron. The Dow fell 2.5% for its worst day of the year, and the S&P also tumbled 2.3%. Oil prices and travel stocks also got rocked given fresh worries over travel demand, while “stay-at-home” names like Peloton and Zoom got a boost.
Economy: It’s still way too early to know the impact of Omicron on economic growth. As we laid out last week, the Fed is under pressure to accelerate the winding down of its stimulus measures in order to battle inflation, but the new variant could change the calculus. Investors dialed back their expectations of a sooner-than-expected rate increase on Friday.
John W. “Jack” Travis, MD, MPH, completed his medical degree at Tufts University and a residency in preventive medicine at Johns Hopkins, where he received a Masters in Public Health and created one of the first computerized Health Risk Assessments (HRAs).
Dr. Jack joins colleague Pete R. Peter R. Quinones to describe what he refers to as the “weaponization of vaccines” and specifically concentrates on the CV19 “vaccines”.
A recent study from Physicians Advocacy Institute (PAI), prepared by Avalere Health, associated the growing number of both physician practice acquisitions and employed physicians between 2019 and 2021 with the COVID-19 pandemic.
To study COVID-19’s impact on physician employment trends, the June 2021 study evaluated the IQVIA OneKey database that contains physician practice and health system ownership information.
To assess these trends at a national and regional level, Avalere researchers studied the two-year period from January 1, 2019 to January 1, 2021. (Read more…)
The appropriate focus in managing the COVID-19 pandemic in the United States has been addressing access and delivery of care to the population affected by the outbreak. All sectors of the U.S. economy have been significantly affected,including physicians. Physician groups of all specialties and sizes have experienced the financial effects of the pandemic.Hospitals have received billions of dollars to support and enable them to manage emergencies and cover the costs of the disruption.
However, many vascular surgeons are under great financial pressure because of the postponement of all non-emergency procedures. The federal government has announced a myriad of programs in the form of grants and loans to reimburse physicians for some of their expenses and loss of revenue. It is more than likely that unless the public health emergency subsides significantly, many practices will experience dire consequences without additional financial assistance.
The authors have attempted to provide a concise listing of such programs and resources available to assist vascular surgeons who are small businesses in accessing these opportunities.
The COVID-19 pandemic has spurred—and aggravated—a range of mental health and substance use issues in the United States.
In this episode of Critical Point, Milliman’s Stoddard Davenport discusses the rising demand for mental health services and how different populations are being affected. Stoddard also highlights recent statistics on the topic and what the road ahead may look like for mental health in America.
By Darrell Pruitt DDS and David E. Marcinko MBBS, MBA
Anosmia, also known as smell blindness, is the loss of the ability to detect one or more smells. Anosmia may be temporary or permanent. It differs from Hyposmia which is a decreased sensitivity to some or all smells.
According to Wikipedia, Anosmia can be due to a number of factors, including an inflammation of the nasal mucosa, blockage of nasal passages or a destruction of one temporal lobe. Inflammation is due to chronic mucosa changes in the lining of the paranasal sinus and in the middle and superior turbinates. When anosmia is caused by inflammatory changes in the nasal passageways, it is treated simply by reducing inflammation. It can be caused by chronic meningitis and neurosyphilis that would increase intracranial pressure over a long period of time, and in some cases by ciliopathy, including ciliopathy due to primary ciliary dyskinesia. The term derives from the New Latin anosmia, based on Ancient Greek ἀν- (an-) + ὀσμή (osmḗ, “smell”; another related term, hyperosmia, refers to an increased ability to smell). Some people may be anosmic for one particular odor, a condition known as “specific anosmia”. The absence of the sense of smell from birth is known as congenital anosmia.
Ageusia is the loss of taste functions of the tongue, particularly the inability to detect sweetness, sourness, bitterness, saltiness, and umami. It is sometimes confused with anosmia – a loss of the sense of smell. Because the tongue can only indicate texture and differentiate between sweet, sour, bitter, salty, and umami, most of what is perceived as the sense of taste is actually derived from smell. True Ageusia is relatively rare compared to Hypogeusia – a partial loss of taste – and Dysgeusia – a distortion or alteration of taste.
ASSESSMENT:
If you should suddenly lose your sense of smell (anosmia), you might want to get tested for COVID-19 – even without the presence of other symptoms.
“A majority of COVID-19 patients experience some level of anosmia, most often temporary. Analyses of electronic health records indicate that COVID-19 patients are 27 times more likely to have smell loss but are only around 2.2 to 2.6 times more likely to have fever, cough or respiratory difficulty, compared to patients without COVID-19.”
See: “How COVID-19 Causes Loss of Smell – Olfactory support cells, not neurons, are vulnerable to novel coronavirus infection.” By Kevin Jiang for Harvard Medical School, July 24, 2020.
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